Introduction
The purpose of this report will be to explain the nature of congenital syphilis transmission in Louisiana. Particular attention will be paid to contributing factors for the vertical transmission of syphilis, preventative measures, and treatment options for infected infants. It is highly necessary that these issues be explored due to an increasing prevalence of new births with congenital syphilis within the state of Louisiana. This paper will paint a clear picture of the issue, providing relevant definitions when necessary. This paper will establish the significance of the issue within the public health field, as well as its prevalence, potential causes, application across the socioecological-model, and a proposed approach to address it.
Socioecological Model
At the individual level, lack of knowledge regarding one’s own syphilis status and lack of knowledge regarding available treatment options for the disease are major risk factors for mothers to vertically transmit syphilis. An important protective measure at the individual level would be receiving regular screening for syphilis and being aware of positive or negative status for the disease. Another protective factor would include having prior knowledge of prevention methods, both to avoid initially contracting syphilis and to avoid transmitting the disease to the fetus during pregnancy. Knowledge of the adverse birth outcomes for children born with congenital syphilis can be considered another protective factor, as it may lead mothers to seek additional information and treatment options to prevent or control congenital syphilis.
At the interpersonal level, risk factors include mothers having one or more sexual partners of unknown STD status or having one or more sexual partners who test positive for syphilis. At the interpersonal level, a protective measure could include engaging in a long-term, monogamous sexual relationship with someone who has tested negative for syphilis or engaging only in nonsexual relationships.
At the organizational level, inadequate provision of sexual health information within educational institutions may increase risk of future-mothers transmitting syphilis to offspring. An additional risk factor at the organizational level would be a disparity in the number and quality of treatment options for women who are uninsured or underinsured. A protective measure at the organizational level could include partner services and screening programs implemented by public health departments. Additionally, to prevent vertical syphilis transmission on the organization level, Health Departments and local health care delivery systems could increase access to syphilis testing, treatment, clinical services, and health education. Health departments could work in conjunction with prenatal care providers to address socioeconomic barriers for pregnant women to receive care.
Community risk factors that would prevent a woman from receiving screening for syphilis could include sexual taboos within certain social and religious groups and the stigmatization of STD positive individuals. However, media influences and “hook-up culture,” which promote risky behaviors such as having multiple sexual partners, also pose a community risk. Some possible protective measures at the community level would include increasing the acceptability, accessibility, and availability of condoms; encouraging STD testing and screening; and removing the stigma of being STD positive.
Some risk factors at the policy level could include a lack of laws regarding the necessity of syphilis screenings in newborns and during pregnancies. A protective measure at the policy level would be the required reporting of syphilis cases during pregnancy to the local or state health department.
Background
The problem to be discussed in this report is congenital syphilis in Louisiana. While syphilis is classified as a sexually transmitted disease, this infection may also be transmitted from mother to child in utero or during birth. Congenital syphilis is defined as the infection that
occurs when a syphilis-infected mother passes the infection to her baby during pregnancy.
Congenital syphilis is a serious but preventable public health problem that has become increasingly prevalent in recent years, especially within the state of Louisiana (CDC, 2018).
Between 2012 and 2018, the United States experienced an increase in its total number of syphilis reports. The rate of congenital syphilis cases in the United States jumped from 8.4 to 11.6 cases per 100,000 live births. Similarly, the number of new syphilis cases among women increased during this period (CDC, 2015). In 2017, the number of congenital syphilis reports reached a twenty-year record high, with 918 cases reported. This marks a 153.59% increase since 2013 when 362 new cases were reported. In 2017, there were 64 stillbirths and 13 infant deaths resulting from congenital syphilis (CDC, 2018).
Louisiana produced 59 new cases of congenital syphilis during 2017. As of 2018, per every 100,000 live births within the state of Louisiana, 93 are infected with congenital syphilis. Today, the numbers of new congenital syphilis reports continue to grow both in the state of Louisiana and across the entire United States (CDC, 2018).
Congenital syphilis is caused by Treponema pallidum, a spirochete bacterium (Broutet et al., 2016). A child becomes infected with congenital syphilis when Treponema pallidum is transferred from mother to child either in utero or at the time of birth. This transmission can occur during any stage of gestation. The infection is most commonly transmitted to a fetus via the placenta (Arnold, 2000).
The increase in the number of congenital syphilis cases in recent years can be attributed to failures within the public health and healthcare systems. Though the United States Preventative Services Task Force and the Centers for Disease Control and Prevention recommend syphilis screening at a pregnant woman’s first prenatal care visit and again in the third trimester for women at increased risk for acquiring the disease, healthcare providers oftentimes fail to follow these guidelines. Since syphilis may be asymptomatic, many infected people do not seek screening or treatment. Congenital syphilis can be prevented if women with syphilis are identified and treated prior to or early on in pregnancy (Matthias et al., 2017). Symptoms can be minimized if infected infants are identified and treated early in life (CDC, 2018).
If left untreated, congenital syphilis may cause a wide range of health complications. Congenital syphilis may cause miscarriage, still or premature birth, low birth weight, or death shortly after birth. Babies born with congenital syphilis may have skin rashes, jaundice, deformed bones, brain and nerve problems resulting in deafness or blindness, severe anemia, enlarged liver and spleen, or meningitis. Some infants with congenital syphilis are born without symptoms but develop serious health problems during their first few weeks of life or even years later. Babies that do not receive treatment after failing to show symptoms early on may die from the disease, be developmentally delayed, or experience seizures (CDC, 2018).
In the United States, congenital syphilis disproportionately affects infants born to mothers of different races. According to data collected between 2013 and 2017, infants born to black mothers are at the highest risk for congenital syphilis. In 2017, 347 infants with congenital syphilis were born to Black mothers, indicating a rate of 58.9 congenital syphilis cases per 100,000 live births. The data indicated that infants born to American Indian and Alaskan Native mothers are at the second highest risk for the disease. In 2017, 13 cases were reported, indicating a rate of 35.5 cases per 100,000 live births. Infants born to Hispanic mothers have the third highest risk for congenital syphilis. In 2017, 308 cases were reported, indicating a rate of 33.5 cases per every 100,000 live births (CDC, 2018).
Infants born to mothers and families of low socioeconomic status are also at increased risk for developing congenital syphilis. Socioeconomic status may impact both access to and quality of healthcare. Women with low socioeconomic status are less likely to have access to affordable screening or treatment for syphilis, therefore their children are at higher risk for congenital syphilis (Caires et al., 2017).
Intervention for Congenital Syphilis in Louisiana
Congenital syphilis is a serious but preventable disease. Its high prevalence in the state of Louisiana is an indicator of serious failures in the public health system. One method of intervention to combat the problem of congenital syphilis in Louisiana would be health teaching in primary care settings. Health teaching involves the communication of ideas, facts, and skills that change knowledge, beliefs, values, attitudes, behaviors, and practices of communities, systems, families, or individuals. Health teaching in primary care settings is an educational intervention that addresses the organizational level of the socio-ecological model (Minnesota Department of Health, 2001).
The intervention of health teaching in primary care settings includes the education of primary care providers such as physicians, clinical nurse specialists, physician assistants, and nurse practitioners on congenital syphilis, its risk factors, and prevention (Department of Health & Human Services, 2018). The Louisiana Department of Health is currently working towards the eradication of congenital syphilis and control of other sexually transmitted diseases through its STD/ HIV Program. One of this program’s goals is to strengthen partnerships with local healthcare providers to improve preventative care (Louisiana Academy of Family Physicians, 2017). Increasing rates of new congenital syphilis cases in Louisiana in spite of preventative efforts by the state’s department of public health are an indicator of failures in primary care.
The CDC has noted that only one third of physicians have received training in sexually transmitted diseases post medical school (CDC, 2017). It is imperative that healthcare workers in primary care settings are well-informed about syphilis, prevention methods, and timely treatment options. The World Health Organization has attributed a lack of adequate care to be the greatest factor leading to the resurgence of congenital syphilis (Afadapa, et al., 2004). Health teaching in primary care settings for the prevention of congenital syphilis could require physicians and other primary care providers to receive mandatory education on the CDC’s guidelines for STD Treatment in order to practice. Primary care locations could also require employees to complete an annual seminar regarding information on syphilis control.
The target population of this intervention would be physicians, clinical nurse specialists, physician assistants, and nurse practitioners in primary care practices. Targeting primary care providers in areas with high numbers of people with syphilis may be most beneficial. The Shreveport and Baton Rouge areas have the greatest numbers of syphilis cases in the state of Louisiana, therefore implementation of health teaching in primary care settings of those areas may be most effective in reducing the numbers of new cases statewide (Louisiana Academy of Health & Human Services, 2018).
There evidence to support syphilis education in primary care settings as an effective intervention to reduce incidence of the disease in Louisiana. A quasi-experimental study conducted in Londrina, Brazil from 2013 to 2015 has demonstrated educational intervention in primary care settings to be an effective method to prevent congenital syphilis. Educating healthcare workers in Londrina primary care settings led to improvements in early detection of gestational syphilis. This intervention also led to a reduction in the vertical transmission rate of the disease. It is possible that this intervention contributed to the elimination of syphilis-specific mortality in children under one year in 2014 and 2015 (Barbosa & Lazarini, 2017).
Conclusion
Despite the existence of obvious preventative and curative options, rates of congenital syphilis continue to increase across the United States. The state of Louisiana’s high rates of congenital syphilis can only be partially attributed to healthcare barriers such as poverty and lack of accessibility of care. A major factor contributing to the congenital syphilis epidemic of Louisiana is a lack of awareness regarding the disease and the methods to prevent and treat it. Public health efforts to combat this disease must begin with the education of both patients and workers in primary care settings.
...(download the rest of the essay above)